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Peer-reviewedCC BY-NC-NDLancet regional health. Americas

Nicotine and tobacco product use among US youth in 10th and 12th grade, 2023-2025: a repeated cross-sectional study.

  • Dayoung Bae1,2
  • Junhan Cho1,2,3
  • Alyssa F Harlow1,2
  • Yi-Chun Chang1,2
  • Louisiana M Sanchez1,2
  • Steve Y Sussman1,2,3
  • Hongying D Dai4
  • Leah Meza1,2
  • Megan E Patrick5
  • Brian A King6
  • Richard A Miech5
  • Adam M Leventhal1,2,3
6 affiliations
  1. 1Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
  2. 2Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA.
  3. 3USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
  4. 4Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA.
  5. 5Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
  6. 6Campaign for Tobacco-Free Kids, Washington, DC, USA.
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Abstract

Background

Youth nicotine/tobacco use has shifted in recent decades. Updated national estimates are essential for policy and practice. We examined changes in youth nicotine/tobacco use in the United States (US) across three annual surveys (2023-2025) and assessed sociodemographic correlates and multi-product co-use patterns in 2025.Methods

Self-reported lifetime and past-30-day use of seven nicotine/tobacco products were analyzed among US 10th and 12th graders (2023-2025; n = 47,524; mean age 17.0 years [standard deviation 1.1]; 47.5% female, 48.6% male, 3.8% reported another sex or preferred not to report; 41.0% non-Hispanic White, 22.3% Hispanic, 16.5% Multiracial, 13.7% non-Hispanic Black) in Monitoring the Future's nationally representative cross-sectional survey. Changes in prevalence across the three survey years were examined using survey-weighted log-binomial regression.Findings

Lifetime nicotine pouch use increased from 3.1% in 2023 to 7.5% in 2025 (average annual prevalence ratio [PR] 1.53, 95% confidence interval [CI] 1.32-1.78, p < 0.0001), and past-30-day use rose from 1.2% to 2.9% (PR 1.45, 95% CI 1.19-1.75, p = 0.0012). Prevalences were largely unchanged for past-30-day cigar/cigarillo, combustible cigarette, e-cigarette, hookah, nicotine candy, and smokeless tobacco use and lifetime cigarette, e-cigarette, and smokeless tobacco use. In 2025, e-cigarettes were the most used product, followed by nicotine pouches. Use of several products was higher among male, rural, non-Hispanic White, and Multiracial youth, and those with lower parental education. Among users, co-use of multiple products was prevalent, with the strongest associations observed for combustible cigarette-e-cigarette co-use and nicotine pouch-smokeless tobacco co-use.Interpretation

There was little evidence of change in US youth nicotine/tobacco use, except for rising nicotine pouch use. Combustible tobacco use remained at historically low levels. In 2025, use was concentrated in sociodemographic groups and marked by high multi-product use.Funding

National Cancer Institute, National Institute on Drug Abuse, US Food and Drug Administration, and Tobacco-Related Disease Research Program of the University of California.

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Cite

BibTeXRIS
BibTeX
@article{bae2026nicotine,
  title = {{Nicotine and tobacco product use among US youth in 10th and 12th grade, 2023-2025: a repeated cross-sectional study.}},
  author = {Dayoung Bae and Junhan Cho and Alyssa F Harlow and Yi-Chun Chang and Louisiana M Sanchez and Steve Y Sussman and Hongying D Dai and Leah Meza and Megan E Patrick and Brian A King and Richard A Miech and Adam M Leventhal},
  journal = {Lancet regional health. Americas},
  year = {2026},
  month = oct,
  doi = {10.1016/j.lana.2026.101673},
  url = {https://europepmc.org/article/MED/42909247},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Nicotine and tobacco product use among US youth in 10th and 12th grade, 2023-2025: a repeated cross-sectional study.
AU  - Dayoung Bae
AU  - Junhan Cho
AU  - Alyssa F Harlow
AU  - Yi-Chun Chang
AU  - Louisiana M Sanchez
AU  - Steve Y Sussman
AU  - Hongying D Dai
AU  - Leah Meza
AU  - Megan E Patrick
AU  - Brian A King
AU  - Richard A Miech
AU  - Adam M Leventhal
PY  - 2026
DA  - 2026/10/14
JO  - Lancet regional health. Americas
DO  - 10.1016/j.lana.2026.101673
UR  - https://europepmc.org/article/MED/42909247
AB  - Background  Youth nicotine/tobacco use has shifted in recent decades. Updated national estimates are essential for policy and practice. We examined changes in youth nicotine/tobacco use in the United States (US) across three annual surveys (2023-2025) and assessed sociodemographic correlates and multi-product co-use patterns in 2025.Methods  Self-reported lifetime and past-30-day use of seven nicotine/tobacco products were analyzed among US 10th and 12th graders (2023-2025; n = 47,524; mean age 17.0 years [standard deviation 1.1]; 47.5% female, 48.6% male, 3.8% reported another sex or preferred not to report; 41.0% non-Hispanic White, 22.3% Hispanic, 16.5% Multiracial, 13.7% non-Hispanic Black) in Monitoring the Future's nationally representative cross-sectional survey. Changes in prevalence across the three survey years were examined using survey-weighted log-binomial regression.Findings  Lifetime nicotine pouch use increased from 3.1% in 2023 to 7.5% in 2025 (average annual prevalence ratio [PR] 1.53, 95% confidence interval [CI] 1.32-1.78, p < 0.0001), and past-30-day use rose from 1.2% to 2.9% (PR 1.45, 95% CI 1.19-1.75, p = 0.0012). Prevalences were largely unchanged for past-30-day cigar/cigarillo, combustible cigarette, e-cigarette, hookah, nicotine candy, and smokeless tobacco use and lifetime cigarette, e-cigarette, and smokeless tobacco use. In 2025, e-cigarettes were the most used product, followed by nicotine pouches. Use of several products was higher among male, rural, non-Hispanic White, and Multiracial youth, and those with lower parental education. Among users, co-use of multiple products was prevalent, with the strongest associations observed for combustible cigarette-e-cigarette co-use and nicotine pouch-smokeless tobacco co-use.Interpretation  There was little evidence of change in US youth nicotine/tobacco use, except for rising nicotine pouch use. Combustible tobacco use remained at historically low levels. In 2025, use was concentrated in sociodemographic groups and marked by high multi-product use.Funding  National Cancer Institute, National Institute on Drug Abuse, US Food and Drug Administration, and Tobacco-Related Disease Research Program of the University of California.
SN  - 2667-193X
ER  -